Manualmusletesting

1. Normal & Good
• Position:
• Sitting with hand resting palm upward on table and fingers
extended.
• Stabilization:
• Stabilize middle phalanx of finger.
• Desired Motion:
• Patient flexes distal phalanx.
• Resistance:
• Is given on palmar surface of distal phalanx of finger

2. Fair & Poor
• Patient flexes distal phalanx through full ROM for
fair grade and through partial range for poor grade.

3. Trace & Zero
• Flexor digitorum profundus may be palpated
on the palmar surface of the middle phalanx

4. Caution!!!!

5. Extension of metacarpophalangeal joints of fingers
Extensor digitorum communis Extensor indicis proprius Extensor digiti minimiExtensor digitorum communis Extensor indicis proprius Extensor digiti minimi

6. Muscles contribute to Extension of
metacarpophalangeal joints of fingers
Extensor digitorum communisExtensor digitorum communis
• Origin:
• Common extensor origin on anterior aspect of lateral epicondyle
of humerus
• Insertion:
• External expansion to middle and distal phalanges by four
tendons. Tendons 3 and 4 usually fuse and little finger just
receives a slip
• Action:
• Extension of MP joints
• Nerve supply

7. Muscles contribute to Extension of
metacarpophalangeal joints of fingers
Extensor indicis propriusExtensor indicis proprius
• Origin:
• Lower posterior shaft of ulna (below extensor pollicis longus) and
adjacent interosseous membrane
• Insertion:
• Extensor expansion of index finger (tendon lies on ulnar side of
extensor digitorum tendon)
• Action:
• Extension of MP joints
• Nerve supply

8. Muscles contribute to Extension of
metacarpophalangeal joints of fingers
Extensor digiti minimiExtensor digiti minimi
• Origin:
• Common extensor origin on anterior aspect of lateral epicondyle
of humerus
• Insertion:
• Extensor expansion of little finger-usually two tendons which are
joined by a slip from extensor digitorum at metacarpophalangeal
joint
• Action:
• Extension of MP joints
• Nerve supply

9. Normal & Good
• Position:
• Arm resting on table, hand
supported, wrist in midposition,
fingers flexed.
• Stabilization:
• Stabilize metacarpals.
• Desired Motion:
• Patient extends proximal row of
phalanges with IP joints partially
flexed.
• Resistance :
• Is given on dorsal surface of
proximal row of phalanges of
fingers.

10. Fair & Poor
• Position:
• Sitting with hand supported, fingers
flexed and wrist in midposition.
• Stabilization:
• Stabilize metacarpals.
• Desired Motion:
• Patient extends proximal row of
phalanges to end of range, with IP
joints partially flexed.
• Patient extends MCP joints through
full ROM for grade of fair and
through partial range for grade of
poor

11. Trace & Zero
• The tendons of the finger extensors may easily be
located on dorsum of hand where they pass over
metacarpals.

12. Finger Abduction
Interossei dorsales Abductor digiti minimiInterossei dorsales Abductor digiti minimi

13. Muscles contribute to Finger Abduction
Interossei dorsalesInterossei dorsales
• Origin:
• Bipennate from inner aspects of shafts of all
metacarpals
• Insertion:
• Proximal phalanges and dorsal extensor
expansion on radial side of index and middle
fingers and ulnar side of middle and ring
fingers
• Action:
• Finger Abduction
• Nerve supply

14. Muscles contribute to Finger Abduction
Abductor digiti minimiAbductor digiti minimi
• Origin:
• Pisiform bone, pisohamate ligament and flexor
retinaculum
• Insertion:
• Ulnar side of base of proximal phalanx of little
finger and extensor expansion
• Action:
• Finger Abduction
• Nerve supply

15. Normal & Good
►Test for first and third Interossei dorsales
• Position:
• Sitting with hand supported palm downward,
fingers adducted.
• Stabilization:
• Stabilize metacarpals.
• Desired Motion:
• Patient abducts fingers.
• Resistance:
• Is given on radial side of second and ulnar side
of third finger, (To test individual fingers,
resistance is given on first phalanx)

16. Normal & Good
►Test for second and fourth Interossei
dorsales and Abductor digiti minimi
• Position:
• Sitting with hand supported palm
downward, fingers adducted.
• Stabilization:
• Stabilize metacarpals.
• Desired Motion:
• Patient abducts fingers.
• Resistance:
• Is given on ulnar side of fourth and fifth
fingers and on radial side of third finger.

17. Fair & Poor
• Position:
• Sitting with palm resting on table,
fingers adducted.
• Desired Motion:
• Patient abducts fingers through
ROM. (Third finger must be moved
in both directions.)
• Patient abducts fingers through full
ROM for fair grade and through
partial range for poor grade.

18. Trace & Zero
• The Interossei dorsales lie deep between the metacarpal bones
on the dorsum of the hand.
• (Palpation of first Interosseus dorsales shown in illustration.)

19. Fingers Adduction
Interossei palmaresInterossei palmares

20. Muscles contribute to Finger Adduction
Interossei palmaresInterossei palmares
• Origin:
• Entire length of second, fourth and fifth
metacarpal bones on palmar surface
• Insertion:
• Side of base of proximal phalanx of
corresponding finger: first into ulnar side of
index finger; second and third into radial side of
ring and little fingersInto aponeurotic expansion
of Extensor digitorum tendon of same finger
• Action:
• Finger Adduction
• Nerve supply

21. Normal & Good
• Position :
• Sitting with hand supported palm
clown ward, fingers abducted.
• Desired Motion:
• Patient adducts fingers.
• Resistance:
• Is given in radial direction on
second finger and in ulnar
direction on fourth and fifth
fingers.

22. Fair & Poor
• Position:
• Sitting with hand resting palm
downward on table, fingers in
abduction.
• Desired Motion:
• Patient adducts fingers through full
range of motion for fair grade and
through partial range for poor grade

23. Trace & Zero
• Presence of contraction of the Interossei palmares
may be determined by outward pressure on the
second, fourth and fifth fingers as the patient
attempts to adduct

25. Flexion of Metacarpophalangeal & Interphalangeal of
Thumbs joints
Flexor pollicis Brevis Flexor pollicis LongusFlexor pollicis Brevis Flexor pollicis Longus

26. Muscles contribute to Flexion of Metacarpophalangeal
& Interphalangeal of Thumbs joints
Flexor pollicis BrevisFlexor pollicis Brevis
• Origin:
• Flexor retinaculum and tubercle of trapezium
• Insertion:
• Base of proximal phalanx of thumb (via radial
sesamoid)
• Action:
• Flexion of MP & IP of the thumb
• Nerve supply

27. Muscles contribute to Flexion of Metacarpophalangeal
& Interphalangeal of Thumbs joints
Flexor pollicis LongusFlexor pollicis Longus
• Origin:
• Anterior surface of radius below anterior
oblique line and adjacent interosseous
membrane
• Insertion:
• Base of distal phalanx of thumb
• Action:
• Flexion of MP & IP of the thumb
• Nerve supply

28. Flexion of MCP Joint of Thumb

29. Normal & Good
• Position:
• Sitting with hand resting palm upward on
table.
• Stabilization:
• Stabilize first metacarpal.
• Desired motion:
• Patient Flexes first phalanx of thumb. &
distal phalanx remains relaxed.
• Resistance:
• Is given on palmar surface of proximal
phalanx

30. Fair & Poor
• Patient flexes first phalanx of thumb through
full ROM for fair grade and through partial
range for poor grade